The Alzheimer’s Association is committed to connecting clinicians to effective, evidence-based models of care that can be replicated in community settings. Two of these models — the UCLA Alzheimer’s and Dementia Care program and the Age-Friendly Health Systems initiative — are detailed below.
A dementia-specific model of care that significantly improved the experience for caregivers and people living with the disease.
About the program
The Alzheimer’s Association has partnered with UCLA to replicate the UCLA Alzheimer’s and Dementia Care (ADC) program through a grant from the John A. Hartford Foundation. The program follows a co-management model within the UCLA health system and partners with community-based organizations (CBOs) to provide comprehensive, coordinated, individualized care for people living with Alzheimer’s disease and other dementias.
The goals of the program are to:
- Maximize function, independence and dignity for people living with dementia.
- Minimize caregiver strain and burnout.
- Reduce unnecessary costs through improved care.
To qualify for the program, participants must have a diagnosis of dementia and live outside of a nursing home. The mean age of the first program participants was 82 years old. Almost all of the caregivers were the children (59%) or spouses (41%) of individuals living with Alzheimer’s or other dementias.
The ADC program utilizes a co-management model in which a nurse practitioner Dementia Care Specialist (DCS) partners with the participant’s primary care doctor to develop and implement a personalized care plan. The DCS provides support via four key components:
- Conducting in-person needs assessments of individuals living with Alzheimer’s and their caregivers.
- Creating and implementing individualized dementia care plans.
- Monitoring and revising care plans, as needed.
- Providing access 24/7, 365 days a year for assistance and advice to help avoid Emergency Department (ED) visits and hospitalizations.
The ADC program also connects caregivers with resources provided by CBOs, including:
- Adult day care.
- Case management.
- Legal and financial advice.
- Workforce development focused on training families and caregivers.
At one year, the quality of care provided by the program as measured by nationally accepted quality measures for dementia was exceedingly high — 92% compared to a benchmark of 38%. As a result, the improvements experienced by both caregivers and patients were significant:
- Ninety-four percent of caregivers felt that their role was supported.
- Ninety-two percent would recommend the program to others.
- Confidence in handling problems and complications of Alzheimer’s and other dementias improved by 79%.
- Caregiver distress related to behavioral symptoms, depression scores and strain improved by 31%, 24% and 15%, respectively.
- Despite disease progression, behavioral symptoms like agitation, irritability, apathy and nighttime behaviors in people living with dementia improved by 22%.
- Depressive symptoms experienced by individuals living with the disease were reduced by 34%.
Cost benefits of the program
An external evaluator compared utilization and cost outcomes and determined that over the course of 3 1/2 years, participants in UCLA’s program had lower total Medicare costs of care ($2,404 per year) relative to those receiving usual care.
In addition to cost savings for individuals and their families, the ADC program reports several financial benefits for health systems, including:
- Hospitalizations: 12% reduction
- ED visits: 20% reduction
- ICU stays: 21% reduction
- Hospital days: 26% reduction
- Hospice in last six months: 60% increase
- Nursing home placement: 40% reduction
UCLA finds that a care program following the ADC model may be able to pay for itself depending on local labor costs, comprehensiveness of billing and local overhead applied to clinical revenue.
To learn more or to contact UCLA about training and replication of the program, visit the UCLA Alzheimer’s and Dementia Care Program website.
Age-Friendly Health Systems initiative
A model of care that incorporates person-centered dementia care into a broader framework for the care of older adults.
About the initiative
Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA). Together in 2017, they set a bold vision to build a social movement so all care with older adults is age-friendly care, that:
- Follows an essential set of evidence-based practices.
- Causes no harm.
- Aligns with “What Matters” to the older adult and their family caregivers.
The Age-Friendly Health Systems initiative defines “What Matters” as knowing and aligning care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.
- Health outcome goals relate to the values and activities that matter most to an individual, help motivate the individual to sustain and improve health, and could be impacted by a decline in health — for example, babysitting a grandchild, walking with friends in the morning, or volunteering in the community. When identified in a specific, actionable, and reliable manner, patients’ health outcome goals can guide decision making.
- Care preferences include the health care activities (e.g., medications, self-management tasks, health care visits, testing, and procedures) that patients are willing and able (or not willing or able) to do or receive.
The 4Ms framework of an Age-Friendly Health System
The 4Ms are not a program, but a framework to guide how care is provided to older adults through every interaction with a health system’s care and services. The 4Ms — What Matters, Medication, Mentation, and Mobility — make the complex care of older adults more manageable because they:
- Identify the core issues that should drive all care and decision making with the care of older adults.
- Organize care and focus on the older adult’s wellness and strengths rather than solely on disease.
- Are relevant regardless of an older adult’s individual disease(s).
- Apply regardless of the number of functional problems an older adult may have, or that person’s cultural, ethnic or religious background.
The 4Ms framework is most effective when all 4Ms are implemented together and are practiced reliably (i.e., for all older adults, in all settings and across settings, in every interaction).
The intention is to incorporate the 4Ms into existing care — rather than layering them on top —to organize the efficient delivery of effective care. This is achieved primarily through redeploying existing health system resources. Many health systems have found they already provide care aligned with one or more of the 4Ms for many of their older adult patients. Much of the effort, then, is to incorporate the other elements and organize care so all 4Ms guide every encounter with an older adult and their family caregivers.
Cost benefits of the initiative
The business case for becoming an Age-Friendly Health System focuses on its financial returns and is stronger when:
- The financial benefits are captured by the health system that is making the investment.
- Utilization and associated expenses of “usual” care are especially burdensome.
- The health system is effective in mitigating those costs.
- The added expense of becoming age-friendly is lower.
See the IHI report, The Business Case for Becoming an Age-Friendly Health System, for guidance on how to make the business case for your health system.
To learn more or to contact IHI about joining the initiative, visit the IHI Age-Friendly Health Systems website.